Individual
MARY TAYLOR IBARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
1400 S COULTER ST, AMARILLO, TX 79106-1786
(806) 414-9100
(806) 354-5717
Mailing address
1400 WALLACE BLVD, AMARILLO, TX 79106-1708
(806) 414-9100
(806) 354-5717
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP132388
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
AP132388
TX
363LG0600X
Gerontology Nurse Practitioner
AP132388
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200678790 A
—
OK
05
—
366677801
—
TX
05
—
366677802
—
TX
05
—
54485525
—
NM
Enumeration date
10/31/2016
Last updated
03/07/2017
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